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it was a concern," she says. Dr. Thornhill hyperventilated the patient to try to get his CO 2 down, but it shot up into the 90s. She took him off mechanical ventilation and bagged him. Possibly fluid in the lungs, she thought, but his chest was clear and breath sounds were equal. She tried to suction the nasogastric tube, but it was patent. Body temperature was normal. Less than a minute later she checked his temp again and it was 104°F. They stopped the surgery and began the malignant hyperthermia protocol that she and the surgical team had practiced over and over again at lunchtime. "You remove a level of anxiety, think more clearly and can focus on the best patient care when you eliminate 'where is everything?'" says Dr. Thornhill. Everyone had an assigned job. The head nurse called the MHAUS (Malignant Hyperthermia Association of the United States) hotline to let them know they had a case. Dr. Thornhill remembers MHAUS being a great resource, telling them that it's normal to see stiffness in the body and bluish-reddish mottling and blotching of the skin. "It was reassuring to know these things are nor- mal." One staff member packed the patient with ice. Another placed an IV line and a J A N U A R Y 2 0 1 6 • O U T PA T I E N TS U R G E R Y. N E T • 6 1 *from the date of manufacture † or until solution is clear Important Safety Information The use of Revonto in the management of malignant hyperthermia crisis is not a substitute for previously known supportive measures. These measures must be individualized, but it will usually be necessary to discontinue the suspect triggering agents, attend to increased oxygen requirements, manage the metabolic acidosis, institute cooling when necessary, monitor urinary output, and monitor for electrolyte imbalance. Patients who receive i.v. dantrolene sodium preoperatively should have vital signs monitored. If patients judged malignant hype If patients judged malignant hyperthermia susceptible are administered dantrolene sodium preoperatively, anesthetic preparation must still follow a standard malignant hyperthermia susceptible regimen, including the avoidance of known triggering agents. Monitoring for early clinical and metabolic signs of malignant hyperthermia is indicated because attenuation of malignant hyperthermia, rather than prevention, is possible. Despite initial satisfacto Despite initial satisfactory response to i.v. dantrolene there have been reports of fatality, which involve patients who could not be weaned from dantrolene after initial treatment. The administration of i.v. dantrolene is associated with loss of grip strength and weakness in the legs, as well as drowsiness and dizziness. There have been reports of thrombophlebitis following administration of intravenous dantrolene. Tissue necrosis secondary to extravasation has been reported. Injection site reactions (pain, erythema, swelling), commonly due to extravasation, have been reported. Fatal and non-fatal liver disorders of an idiosyncratic or hypersensitivity type may occur with dantrolene sodium therap type may occur with dantrolene sodium therapy. To see the full prescribing information visit www.revonto.com. © 2016 US WorldMeds, LLC. Revonto is a registered trademark of US WorldMeds, LLC. 36 month shelf life* Ready to administer in 20 seconds † Visit www.revonto.com or call (877) 411-USWM (8796) to learn more about Revonto and to see the full Prescribing Information. REV-P81-1215 ® Are You Prepared for a CRISIS?